颅神经血管压迫综合征手术治疗的探讨

Microvascular decompression for microvascularly compressive cranial neuropathy

目的总结采用微血管减压术治疗原发性三叉神经痛、面肌痉挛和舌咽神经痛等颅神经血管压迫综合征的临床治疗经验。方法系统回顾2006年1月至2009年3月采用微血管减压术治疗颅神经血管压迫综合征患者256例,其中三叉神经痛134例,面肌痉挛117例,舌咽神经痛5例。结果三叉神经痛患者手术有效率为94.8%,面肌痉挛患者为96.6%,5例舌咽神经痛患者术后症状均消失。本组术后发生轻度不良反应者15例,占5.9%;发生较重并发症6例,占2.3%,没有死亡病例。术后有效的患者中,168例获得随访,平均随访36个月,复发12例,复发率为7.1%。结论微血管减压术是治疗颅神经血管压迫综合征的有效方法,良好的外科手术技能可有效地降低术后并发症的发生。

Objective To summarize the experience in treating microvascularly compressive cranial neuropathy （MCCN）, including trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia, by microvascular decompression. Methods Of 256 patients who were treated by microvascular decompression from January, 2006 to March, 2009, 134 suffered from trigeminal neuralgia, 117 hemifacial spasm and 5 glossopharyngeal neuralgia. Their clinical data were analyzed retrospectively. Results The effective rates of microvascular decompression in the patients with trigeminal neuralgia and ones with hemifacial spasm were 94.2% and 96.6% respectively. The neuralgia disappeared immediately after the operation in 5 patients with glossopharyngeal neuralgia. After the operation, there were the mild reactions in 15 patients, who accounted for 5.9% of all the patients, and there were the severe complications in 6 patients, who accounted for 2.3% of all the patients. No patients died from the surgery. The following up from 6 to 72 months （mean, 36 months） showed that the recurrent rate was 7.1% in 168 of 245 patients with good curative effect. Conclusions The microvascular decompression is an effective method to treat MCCN. The incidence of the postoperative complication can be effectively reduced by the skillful microsurgical technique.